Renal function and outcomes after catheter ablation of patients with atrial fibrillation: The Guangzhou atrial fibrillation ablation registry

Abstract

Chronic kidney disease (CKD) has been associated with incident atrial fibrillation (AF) and its complications, but data from Asian cohorts are limited. To explore the relationship of AF recurrence after catheter ablation (CA) with eGFR as a continuous variable, and with different renal function categories (normal: estimated glomerular filtration rate [eGFR] ≥90mL/min/1.73 m2; mild CKD: eGFR 60-89mL/min/1.73 m2; moderate CKD: eGFR 45-59mL/min/1.73 m2; severe CKD: <45mL/min/1.73 m2), using data from the Guangzhou Atrial Fibrillation Ablation Registry. We studied consecutive symptomatic adult patients with non-valvular AF, refractory to at least one antiarrhythmic drug and eligible for CA, in Guangdong General Hospital between June 2011 and August 2015. Data were available from 1407 consecutive patients (mean age 57.3±11.5 years; 68% men) with non-valvular AF undergoing radiofrequency or cryoballoon ablation. During a mean follow-up of 20.7±8.8 months, 18.6% of patients with paroxysmal AF and 50.5% with non-paroxysmal AF had AF recurrence. On multivariable analysis, eGFR (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.96-0.97) was an independent risk factor for AF recurrence, with a good predictive value (area under the curve 0.74, 95% CI 0.72-0.77; P<0.01). In the normal renal function, and mild, moderate and severe CKD categories, AF recurrence rates were 11.5%, 29.3%, 72.0% and 93.3%, respectively. Compared with normal renal function, there were stepwise increased risks of AF recurrence with mild CKD (HR 3.30, 95% CI 2.55-4.26; P<0.01), moderate CKD (HR 9.43, 95% CI 6.76-13.16; P<0.01) and severe CKD (HR 12.35, 95% CI 6.93-21.99; P<0.01). In a large cohort of Asian patients with AF, renal dysfunction increased the risk of AF recurrence after CA. AF recurrence gradually increased with worsening kidney function in this cohort.